The objections to assisted suicide are misguided

In a recent article in The Observer, philosopher Mary Warnock makes an eloquent plea for assisted suicide in relation to the case of Daniel James, a 23-year old rugby player from Worcester who requested to be helped to die after an accident at a training session last year left him paralyzed from the chest down, and whose parents helped to fulfill his request by travelling with him to an assisted suicide clinic in Switzerland. Warnock has many sound points to make on this issue, and I will not repeat all of them here. Rather, I will consider some of the arguments that those opposed to assisted suicide have presented in response to that particular case.

Opponents of assisted suicide argue that legalizing the practice would lead to a “slippery slope” against which no effective safeguards could be erected, and that people finding themselves in a situation similar to that of Daniel James might feel pressured to end their lives, because they would perceive themselves as economic (or emotional) burdens to others. They also refer to a study of people who have undergone assisted suicide in the American state of Oregon (where the practice is legal), which shows that one in four of these people “have undiagnosed depression and most certainly would not have chosen such a desperate course of action had they been properly treated” (see here, here, and here). If opponents of assisted suicide are correct, British society has no reason to want to remove the legal obstacles currently preventing people like Daniel James from having their wishes fulfilled. Rather than the UK being too restrictive, it is countries like Switzerland that are morally lax on this issue.

Working out an adequate legislation on assisted suicide is by no means an easy matter. Opponents to the legalization of the practice are right that a young person’s desire to die isn’t something that a civilized society can treat lightly and be eager to fulfill. No one, including the economically disadvantaged, should be pressured into ending their lives, nor should someone be helped to die before it has been ascertained that that person doesn’t suffer from a condition that impairs her capacity for making informed decisions. It is also true that sometimes, even when no such condition is discernable, an expressed desire to die will not persist after the person has been provided with adequate psychological support and counselling, and been offered a different, brighter perspective on what her future life might be like. Many people do adjust to serious disability, even if it takes some time.

Yet none of this shows that assisted suicide shouldn’t be legalized, because all of the aforesaid warnings can (and should) be taken into account in a law authorizing the practice. Helping someone to die shouldn’t be a decision made in haste (though in exceptional cases, involving for example a clearly desperate condition leaving the victim in constant excruciating pain, a quick decision might still be morally required). Nevertheless, after a certain amount of time refusing to help such a person ceases to be humane and becomes callous. A law (or set of laws) regulating assisted suicide might stipulate what exact conditions – e.g. how much time must have elapsed in order to allow a “grieving” process to take place, what kinds of support must have been offered, how much suffering the person seems to be experiencing – need to be fulfilled before it can become legitimate to help someone end her life. During the last months of his life Daniel James consistently expressed the desire to die and made several unsuccessful suicide attempts. Even assuming he was “depressed” in some sense, his frame of mind cannot simply be dismissed as a pathological condition or as a temporary state of despair that would have disappeared with time. We also have to take seriously the possibility that, as his own parents suggest, he simply felt profoundly dissatisfied and sad about living what he perceived as a “second-class existence”, and that his dissatisfaction was not a transient feeling. Moreover, there is no doubt that he received strong emotional and daily living support on the part of his family. Of course, one might question whether he got all the support he could possibly have received, including from disabled groups and religious organizations. But whatever the answer to that question, ensuring that people like Daniel James receive all the support they need to avoid choosing death prematurely is compatible with having a law permitting assisted suicide in certain circumstances.

Secondly, what if a person refuses certain forms of support such as pastoral care? Requiring that the person receive such support before being entitled to assisted suicide would seem to violate individual autonomy. At least this is an issue that needs to be discussed and legislated upon. Thirdly, some people (and Daniel James might well have been one of them) will still show an earnest and persistent desire to end their own life after all the relevant support has been provided, and it doesn’t seem that there will be any grounds for declaring their desire unreasonable. It is at least understandable that a gifted rugby player who suddenly finds himself in a condition in which he can no longer practice his favourite activity and depends on others for his elementary needs, and who can expect to remain in such a condition for the rest of his days and to have to renounce the dreams he had for the future, might find that his new life is not worth living. As Warnock remarks, not everyone would respond to such unfortunate circumstances in the same manner. For some people, the presence of certain features in their life is a non-negotiable condition of it being worth living; for others it isn’t. Yet this gives no right to the opponents of assisted suicide to impose their own personal view of what constitutes a life worth living on the rest of society, especially as they are typically not experiencing themselves the conditions that they are asking other people to put up with. A liberal democracy like the UK should be consistent with its own liberal principles and respect the informed choices of its citizens with a life-debilitating condition, not condemn them and their families to needless suffering.

There is no reason in principle why it should prove impossible to include adequate moral safeguards into laws authorizing assisted suicide. If the relevant laws are as specific as they ought to be, it will not be possible for a doctor to use them to justify administering a lethal injection to a youth who was going through a temporary depressive episode, no more than it is currently possible to justify forcing a woman to have an abortion by quoting the 1967 Abortion Act. I conclude that none of the objections considered so far calls into question the moral legitimacy of legalizing assisted suicide, provided that we do so in a responsible manner.

7 Responses to The objections to assisted suicide are misguided

There is some similarity between this issue and that of abortion in that both issues are religiously frought. To most Christians and Muslims and, I think Orthodox Jews, sucide is a sin. Hence excepting assisted suicide from the usual rules against homicide (recall that consent is not a defense) involves the state in furtherance of sin. There is really no answer to this argument, is there?

I guess you’re right that most groups within the main revealed religions are opposed to assisted suicide on moral grounds, and that it might not be possible to show that their position is inconsistent with their moral and religious creeds. Organisations like Care Not Killing, however, do not make use of religious principles in their arguments against assisted suicide, and it is on this secular ground that I have offered my critique of their views. Obviously, this is the ground on which I think the debate should be conducted. When opponents of assisted suicide start putting forward objections of an explicitly religious nature, the debate cannot but shift to the question of the role of religion in influencing state policy.

Thanks for your response to my note. Your last sentence seems to suggest that religion does not now influence discussion of public policy, especially with respect to reproduction, death and dying. It can’t help but influence it in the United States, where religious training in sunday school and religion-based schools is wide-spread. Death is a big deal in the Abrahamic religions and what is said about it in religious venues has to affect the thinking of most people about such things. So, why isn’t religious influence on the matter made public? Here, I engage in insubstantially-based political and psychological guessing. Our traditions in the US make us religious but also shy about bringing up religion in the public forum. Part of that is the civic ideology of “separation of church and state” which flows from the first amendment to our Constitution. The result is a discussion of policy through masks and filters that do not disclose (and hence prevent direct discussion of) the religious roots of that discussion.

Great blog.
On the argument that assisted suicide should not be offered because these people are depressed – who would NOT be depressed if they wanted to die and they were forced to live? Especially if they were so disabled that they could not kill themselves.

You’re certainly right that religion does influence discussion of public policy, both in the US and in the UK. I’m not denying this, nor am I saying that religious people shouldn’t have a say in those discussions, or that they have no right to make use of moral premises that are ultimately founded on their religious beliefs. What I would say is that while it might be legitimate for a religious person, in the specific context of a discussion of public policy (as opposed to a mere expression of one’s personal views), to oppose assisted suicide by invoking the principle that killing oneself is always wrong, it isn’t legitimate for that person, when faced with people who don’t accept that principle, to try and bolster it by claiming that it follows from a divine command. It is this kind of rationale for moral principles which I think has no place in discussions of state policy. For it to deserve such a place, religious people should be able to establish the truth of their creeds beyond reasonable doubt, which as far as I’m aware they cannot do.

The argument presented makes reference to “ascertaining that a person doesn’t suffer from a condition that impairs her capacity for making informed decisions”. It is the key to all non-religious arguments in favour of assisted suicide … that some people want to die because they’re sick, while others have a genuine desire to die. But how can this distinction possibly be made? Just as a religious condemnation of suicide as morally wrong is an extreme arrogance, so is a secular determination of someone’s sanity – or capability for making informed decisions.
There are at least 2 problems here: First the “informed” bit, which assumes a person is well educated, well informed, and capable of requesting further information should they require it. Second, the “Decision” bit, which assumes that all people are good at making decisions, that we somehow understand how all people make decisions, and that we can somehow determine that the person in question is making decisions according to our prescribed methodology.
If we can determine that a person is not in possession of all the facts, yet they refuse to be further educated – is that their individual right to self-determination, or a symptom of an illness such as depression?
If somebody makes decisions according to the draw of Tarot cards (much used by many, however much rationalists rail against it), are they ignorant, deluded, sick, or exercising their right to self-determination?
Certainly, when I discussed this ethical issue with my children, they agreed that someone in unbearable and constant pain with no hope of relief should be allowed to die. But they’ve never tried strong opiates, which I can vouch for as an aid to living happily with constant pain. Everybody has the right to refuse such medication. Would a preference for death rather than opiates be sickness, or a right to self-determination?
Daniel James was with his family to the last – A great example of supportive caring and devotion. But I can state categorically that if I was paralysed from the neck down AND forced to be cared for by my family, I would rapidly become suicidal … but it would be the family end of things that would push me over the edge.
Now, I mean no offence to Daniel’s family, who I have reason to believe treated Daniel in every way in his best interests. My point here is that not every situation is the same, and that appearances can often be deceiving.
My own particular experience of life, and my own particular experience of people, would lead me never, ever to trust somebody who was ready to help me die.

hi there im currently doing my dissertation on euthanasia and agree that religion has a huge influence on decisions made. which i think is wrong because if a person requests help to die for whatever reason and they have made peace with themselves and their ‘God’ then let them die with dignity, painless as possible and with their family around them not forced into a dark room hidden out of the way, wondering if their partner etc will be prosecuted after their death. let them die in peace when they see fit to end it, its no one else’s decision but there’s!!!! p.s what has religion got to do with it its down to personal choice of the HUMAN BEING.